Print out and complete this form, or write out the information on a separate sheet:

There is still room in this camp. To register, email Pete.

[ ] REGULAR TUITION ($225)
[ ] Save $15: $210 if paid in full by Aug. 9, 2012
[ ] Save $10: $215 if paid in full by Sep. 9, 2012
[ ] $95 deposit enclosed, $130 due on arrival.

All but 50% of deposit amount refundable until Oct. 9, 2012.

Name: ________________________________________________

Address: ______________________________________________

City, State, Zip: _________________________________________

Main telephone: ________________________________________

E-mail: _______________________________________________

Check which instruments you play, and circle the main one:
[ ] guitar   [ ] banjo   [ ] mandolin   [ ] fiddle   [ ] bass
[ ] resonator guitar (dobro)   [ ] other: _____________   [ ] none

Do you sing? [ ] yes, know many songs   [ ] a little   [ ] no
Jam experience? [ ] never   [ ] rarely   [ ] 5-15 times   [ ] 16+ times

How did you FIRST hear about this camp?
___ DrBanjo.com
___ magazine ad (which magazine?________________________)
___ radio (what station? ____________)
___ article in newspaper or magazine (which one?_____________)
___ the festival's web site
___ flyer (where?_______________________________________)
___ Dr. Banjo email newsletter
___ music teacher (who? _________________________________)
___ from a former camper (who? ___________________________)
___ other: _____________________________________________)

Mail to:
DR. BANJO 7930-P Oxford Rd. Niwot, CO 80503

Checks payable to Dr. Banjo.